Asian Journal of Anesthesiology
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台灣麻醉醫學會 & Ainosco Press,正常發行
選擇卷期
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Background: Infraumbilical surgery today is done preferentially under subarachnoid block. The relatively short duration of analgesia is a limiting factor which is overcome by adding an adjuvant to intrathecal bupivacaine. We aimed to determine optimum dose of intrathecal dexmedetomidine as adjuvant to 0.5% hyperbaric bupivacaine in infraumbilical surgery. Methods: A parallel group, double blind, randomized controlled trial was done with 105 adult patients posted for infraumbilical surgery under subarachnoid block. All subjects received 3.0 mL (15.0 mg) of 0.5% hyperbaric bupivacaine. Groups D5.0, D7.5, and D10.0 (n = 35 each) received additionally 5.0, 7.5, and 10.0 mcg intrathecal dexmedetomidine as adjuvant. The onset time of sensory block, its peak level and time to this level, maximum motor block and time to it, total duration of analgesia (time to first rescue), and vital parameters were recorded at intervals. Postoperative analgesia was assessed by visual analog scale score at 15 and 30 minutes, then every 30 minutes until 2 hours and then every hour until 6 hours. Treatment emergent adverse events (bradycardia, hypotension, and sedation) were documented. Results: Maximum sensory level achieved was higher in Group D10.0 than in the other two groups. There was significant and dose-dependent shortening of the mean time to peak sensory block (3.9, 3.3, and 2.9 min; P ＜ 0.001) and peak motor block (5.6, 5.3, and 4.8 min; P ＜ 0.001), and prolongation of postoperative analgesia duration (206.9, 220.8, and 244.0 min; P ＜ 0.001) with escalating doses (5.0, 7.5, and 10.0 mcg, respectively) of dexmedetomidine. Hemodynamic effects and adverse events were comparable in the three groups. Conclusions: Intrathecal dexmedetomidine (10.0 mcg), as adjuvant to 0.5% hyperbaric bupivacaine (15.0 mg), facilitates rapid onset sensory and motor block and prolongs duration of postoperative analgesia in spinal anesthesia without significant adverse effects. Although absolute differences are modest, the results are better compared to 5.0 and 7.5 mcg doses.
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Background: The quality of postanesthesia recovery is among the important issues of general anesthesia that affect the patient's ability to perform daily activities. This study hence aimed to investigate the effects of general anesthesia with isoflurane and propofol on the quality of recovery (QoR) in patients undergoing an abdominal hysterectomy. Methods: This clinical trial was conducted on 80 women aged 30-65 years who visited Ayatollah Rouhani Hospital of Babol for an elective abdominal hysterectomy in 2020. Based on a randomized block design (4 blocks of 20), the participants were equally assigned to two groups of propofol (P) and isoflurane (I). The QoR-15 scale was employed to measure the QoR in terms of physical and mental dimensions, as primary outcomes, and duration of anesthesia, duration of surgery, response time, quality of extubation, changes in blood pressure and heart rate, length of stay in the recovery unit, Aldrete score, pain score, and prevalence of postoperative nausea and vomiting (PONV), as secondary outcomes. Results: The results showed that there was no significant difference between the two groups in terms of postoperative physical and mental changes (P = 0.142), except for the second night after surgery (P = 0.001). The QoR, both physically and mentally, significantly changed in both groups over time (P ＜ 0.05). The results also indicated that response time (P ＜ 0.001), quality of extubation (P = 0.01), prevalence of PONV (P = 0.001), and increase in blood pressure (P = 0.02) were significantly lower in the propofol group (P) than in the isoflurane group (I). There was no significant difference between the two groups in the length of stay in the recovery unit (P = 0.44), pre-discharge Aldrete score (P = 0.31), pain score (P = 0.18), duration of anesthesia (P = 0.30), duration of surgery (P = 0.64), and heart rate (P = 0.30). Conclusions: Propofol outperformed isoflurane in terms of response time, quality of extubation, prevalence of PONV, and increase in blood pressure. In addition, the physical and mental QoR on the second night after surgery was higher in patients anesthetized with propofol compared to those anesthetized with isoflurane.
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Background: Adductor canal block (ACB) is a motor sparing block providing analgesia for surgeries involving anterior part of the knee. The aim of our study was to evaluate the analgesic efficacy of ACB to reduce pain in arthroscopic knee surgeries done under spinal anesthesia. Our primary objective was to evaluate the 24 hours postoperative morphine consumption. The secondary objectives were to evaluate the visual analog scale (VAS) scores at rest and during knee flexion, hemodynamics and side effects of the block. Methods: In this prospective randomised controlled trial, 70 patients who underwent arthroscopic knee surgeries were randomly divided into two groups, A and C. Surgeries were done under spinal anesthesia. Group A patients received ACB with 20 mL of 0.5 % ropivacaine using ultrasound postoperatively. Block was not performed in group C. The amount of morphine consumption in PCA pump, duration of analgesia, mean VAS scores at rest and flexion, hemodynamics and adverse effects were monitored. Results: The average morphine consumption was significantly lesser with a P-value ＜ 0.001 in group A (8.628 ± 2.001 mg) when compared to group C (21.914 ± 5.118 mg). The duration of analgesia was longer in group A (365.71 ± 53.648 min vs. 150.429 ± 22.537 min) with highly significant P-value of ＜ 0.001. Group A patients had significantly decreased VAS scores at rest and knee flexion and better haemodynamic stability. Conclusions: We conclude that ultrasound-guided ACB resulted in significantly lesser morphine consumption after arthroscopic knee surgeries. ACB prolonged the duration of analgesia with better hemodynamics, lesser VAS pain scores and with no complications.
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Background: With the increase in the number of people exposed to anesthetic gases, there is a critical need to examine the prevalence of neurotoxic symptoms in these individuals using reliable tools. The aim of this study was to evaluate the psychometric characteristics of EUROQUEST questionnaire and to measure the rate of neurotoxic symptoms in the anesthesiology personnel. Methods: This research was a cross-sectional study. This study was a cross-sectional one. Participants included 404 personnel of the operating room in western Iran. EUROQUEST questionnaire was translated into Persian and used to measure the rate of neurotoxic symptoms. Reliability of the questionnaire was examined by Cronbach's alpha, while face and construct validities were evaluated using SPSS 16 (SPSS Inc., Chicago, IL, USA) and AMOS 18 (IBM, Chicago, IL, USA) software. Results: The results indicated that EUROQUEST questionnaire had acceptable reliability and validity. The most prevalent symptoms were observed in memory and concentration, fatigue, and sleepiness. The prevalence of fatigue was higher than other dimensions, with 28% of participants in the third and fourth quartiles. Also, there was no relationship between symptoms and work experience. Conclusions: EUROQUEST questionnaire can be applied in studies of the neurotoxic symptoms. The study of the prevalence of symptoms also indicated that most participants complained about memory and concentration, fatigue, and sleepiness, and these symptoms were observed in all individuals regardless of their work experience.
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Background: In previous literature, reference values for cerebrospinal fluid (CSF) may be based on patients who were not truly healthy, other species, or outdated information. In the present study, we performed a lumbar puncture in patients requiring spinal anesthesia by a reasonable indication to evaluate CSF parameters in healthy adults. Methods: All patients between the ages of 20 and 70 years scheduled for elective orthopedic or urologic surgery requiring spinal anesthesia were enrolled in this study. We measured electrolytes and gas tension analysis in CSF and whole blood samples in adult humans. Results: A total of 28 patients were included with an average age of 44.2 years. The concentration of Na^+ in blood was slightly lower when compared with that in CSF. There were significantly higher levels of K^+ and Ca^(2+) in the blood when we compared with CSF. Significantly lower levels of Cl^- and Mg^(2+) in the blood were observed when compared with CSF. The glucose level of CSF was about half of that in blood. Conclusions: We provided updated reference values for various solutes in blood and CSF in adults. Analysis of CSF parameters and relevant paired blood samples is highly informative, helping clinicians diagnose a variety of central nervous system diseases.
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Background: Shivering is one of the most common complications of spinal anesthesia because of inhibition of the thermoregulatory control. Dexmedetomidine and nalbuphine are the two commonly used drugs for treatment of perioperative shivering, but owing to paucity of their comparative data, we planned this study to compare the efficacy of these two drugs for treatment of post spinal shivering. Methods: This study was conducted on 80 American Society of Anesthesiologists physical status I or II patients aged from 18 to 60 years who developed post-spinal shivering of grade III or IV during elective surgeries. These patients were randomly allocated into two groups (40 each). In group D, dexmedetomidine 0.50 μg/kg, and in group N, nalbuphine 0.08 mg/kg was given intravenously for treatment of shivering. Data regarding response time, recurrence rate and success rate along with their adverse effects were noted, and statistical analysis was performed using SPSS software version 17.0 (SPSS Inc., Chicago, IL, USA). Results: The mean response time was significantly shorter in group D as compared to Group N (1.9 ± 0.6 min and 4.7 ± 1.1 min, respectively; P ＜ 0.001), but the success rate in both groups was 100%. Recurrence of shivering was greater in group N as compared to group D, but this difference was statistically insignificant. Although hypotension and bradycardia were observed more in group D and nausea was observed more in group N, the difference among both the groups was statistically insignificant. Conclusions: Dexmedetomidine is a better alternative than nalbuphine for treatment of post spinal shivering with quicker response time and comparable side effects.
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Introduction: Decisions on appropriate time of extubation after pediatric neurosurgery are often challenging for anesthesiologists. The primary goal was to investigate the incidence of delayed extubation after pediatric neurosurgery. The secondary goal was to identify the factors affecting delayed extubation in these patients. Methods: This retrospective study was done in pediatric patients who underwent neurosurgery at a university hospital in a 5-year period from April 2015 to March 2020. Delayed extubation was that the patients who were not extubated at the end of procedure before leaving the operating room. Demographic data, preoperative and intraoperative factors associated with delayed extubation were collected and analyzed. Results: A total of 539 pediatric patients were included in our study. There were 56 children in delayed extubation group with the incidence of 10.4%. In the multivariate analysis, the factors associated with delayed extubation were including neonates (adjusted odds ratio [aOR], 3.743; 95% confidence interval [CI], 1.076-13.028), American Society of Anesthesiologists physical status III-IV (aOR, 3.010; 95% CI, 1.057-8.573), preoperative oxygen supplement (aOR, 6.033; 95% CI, 1.713-21.243), intracranial surgery (aOR, 4.494; 95% CI, 1.458-13.847), estimated blood loss (EBL) ≥ 40% of total blood volume (TBV) (aOR, 5.465; 95% CI, 1.640-18.210), and finishing operation after official hours (aOR, 3.810; 95% CI, 1.633-8.889). Conclusions: There were the preoperative and intraoperative factors associated with delayed extubation such as preoperative oxygen supplement, intracranial surgery, or EBL ≥ 40% of TBV. These might be useful for anesthesiologists in making decisions about the planning of extubation after neurosurgery in children.
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The proportion of women taking up anesthesiology and critical care as their careers has increased considerably in the last decade. Currently, women constitute 35%-40% of the total anesthesia workforce in some countries. Most resident doctors and a significant proportion of practicing physicians in anesthesia are in the reproductive age group. They are or will become pregnant at some point in their training program or career. This review focuses on all work-related exposure risks for anesthesia professionals during pregnancy, like risks of infectious diseases, radiation, stress, violence against doctors, and even peer support that can have deleterious effects on the health of pregnant physicians and the health of their unborn fetus. An occupational work environment more compatible with pregnancy is the need of the hour.